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Non-communicable diseases and the world’s government

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Non-communicable diseases or NCDs are the hot topic at the World Health Organisation (WHO) right now. NCDs, including diabetes, cardiovascular disease, some cancers and chronic pulmonary disease account for a large portion of morbidity and mortality in the world, and not just the developed bit. I am told it is Geneva’s big new thing and understandably so. A paper in the New England Journal of Medicine, published last year, said:

The prevalence and impact of noncommunicable diseases continue to grow. Chronic diseases account for 60 per cent of all deaths worldwide, and 80 per cent of these deaths occur in low- or middle-income countries, where the toll is disproportionate during the prime productive years of youth and middle age.

Bulletin, the WHO’s monthly public health journal, feature two editorials on the subject. One focused on how the UN is addressing the issue and the other focused on technical issues of balancing investment in treatment and prevention.

A white gloved hand grips a pale big-toe with a dark cavernous ulcer on its tip: a symptom of diabetes melitus

A diabetic's foot ulcer - this disease has reached pandemic proportions

The global burden of diabetes, as discussed on these pages, is staggering. The study, funded by the Gates’ Foundation and carried out by researchers from a plethora of institutions globally spread, had 2.7 million participants from across the world. In 1980 77 million men and 76 million women had diabetes. In 2008 173 million men and 173 million women had diabetes. Of the up to 194 million additional cases, 70 per cent were attributable to population growth and ageing.

In 2008 about 138 million diabetes cases were from China and India (40 per cent), about 36 million were from the USA and Russia (10 per cent), and about 42 million were from Brazil, Pakistan, Japan and Mexico (12 per cent). It is not just fatties in the West.

Chronic obstructive pulmonary disease (COPD) is one of the world’s leading killers. It killed 3 million people in 2005, that is 5 per cent of all deaths world wide. The causes of COPD rather depend on where you live. In high and middle income countries the main risk factor is smoking. In low income countries it is pollution, specifically indoor pollution caused by burning biomass fuel like wood, dung or charcoal.

A map of the world showing the global spread of mortality from chronic obstructive pulmonary disease. the highest areas are across Africa, China and India

Chronic Obstructive Pulmonary Disease disproportionately affects the world's poorest

Map produced using WHO Global InfoBase

In terms of heart disease, that great killer, it too disproportionately affects the developing world. In 2004 17.1 million people died from cardiovascular disease, 29 per cent of all deaths. 82 per cent of cardiovascular disease deaths are in low- and middle-income countries.

The World Economic Forum (WEF) has published a report that highlights NCDs as “strongly connected to other global risks [to development and growth]: fiscal crisis; under investment in infrastructure; food, water and energy security.” The world’s problems are closely associated and interlinked. With shrinking developments budgets however, money tends to go into the mainstream pots like the Millennium Development Goals (MDGs). “NDCs are not part of the mainstream global health and development agenda” says the report.

The WEF believes stronger global governance is needed to corral the competing and often divergent stake-holders and actors. They need to pull together and do battle with the serous, interconnected obstructions to development. The multisectoral problems like burgeoning consumption of tobacco and alcohol, poor agricultural and industrial practices and inequitable land ownership could be tackled by low-, middle- and high-income governments working together. This would strike at preventing the spread of non-communicable diseases and at the heart of many more of the world’s woes.

A large globe made of strips of steel as lines of longtitude and latitude, and sheets of steel for countries

Better global governance could heal many woes but is it up to scratch?

However the present state of global governance does not fill the confidence quotient quite to the brim. The Eurozone has been well intentioned in tackling its sovereign debt crisis but its ratification process is far too cumbersome. The UN has only just about got round to ticking off the Assad family for butchering their own people in Syria. It seems to be an unwritten rule of journalism that every time the Arab League is mentioned in copy it has to be in conjunction with the word “supine“. The EU is still buying oil from Syria, one of the last sources of revenue for the murderous regime. This is not exactly a roll-call of heroes showing true leadership and winning grand victories. And this is all without mentioning the fundamentally undemocratic World Trade Organisation (WTO).

The WTO is still in the Doha Round of trade talks. It has been stuck in this agonising bout of negotiations for the past ten years; the Doha Round began in November 2001. It should be remembered, this was meant to be the moment when the WTO would finally get round to helping developing countries implement the rules the WTO had already put in place. Those developing countries are the the poor ones the rich ones ought to be helping out because life is really tough when you’re on your uppers. The WTO is symbollic of how badly wrong global governance can go.

Better global governance, with the best intentions, would no doubt be beneficial to the developing and developed world; clubbing together to tackle problems head on. On current form I’m not filled with optimism.

However in September this year the UN will convene a high-level meeting of heads of state to discuss the NCD problem. According to Bulletin:

Just as the HIV/AIDS high-level meeting in 2001 marked a turning point in the HIV epidemic this meeting provides an oportunity to raise priority given to NCDs within the global development agenda.

Ten years after that HIV/AIDS summit there are promising sounds coming from researchers and officials about that pandemic. Perhaps a decade down the line the same will be true about the NCD crises. However these chronic diseases are going to be much harder to clobber than HIV/AIDS. The multiple diseases in that acronym will only be beaten down with massive investment across multiple infrastructures for both prevention and treatment. Not to mention investment in applied research and beating off the siren’s call of the alcohol, tobacco and junk food lobbies.

The balance between combatting the causes of NCDs, be it pollution, tobacco, alcohol or brutally unjust labour laws, with treating those suffering now is paramount. The world’s medical professionals, in all countries across the income spectrum, need to foster and work with patient groups. Vocal grass-roots activism has boosted the fight against communicable diseases – HIV in particular – because politicians responded to voter pressure. If this could be replicated with NCDs, this would not only answer the ethical imperative to treat people who are sick but also emphasis on treatment at a government level will enhance health services. It is vital for infrastructures to be built on detecting cases and treating them early. This increases the chances of recovery and so enhances an individuals earning potential. This boosts development. Furthermore early detection and treatment reduces the overall cost to the health system and liberates resources.

As Bulletin editorial writers put it: “Reducing the burden of NCDs is no longer just a technical issue, but a political problem.” Animation on the global scale can only come from impetus at a local level. It is time for the NCD sufferers and their doctors and nurses to speak up and shout.

Images by Papa1234 and Pharos respectively

Narayan, K., Ali, M., & Koplan, J. (2010). Global Noncommunicable Diseases — Where Worlds Meet New England Journal of Medicine, 363 (13), 1196-1198 DOI: 10.1056/NEJMp1002024
Alwan, A., Galea, G., & Stuckler, D. (2011). Development at risk: addressing noncommunicable diseases at the United Nations high-level meeting Bulletin of the World Health Organization, 89 (8), 546-546 DOI: 10.2471/BLT.11.091074
Maher, D., & Ford, N. (2011). Action on noncommunicable diseases: balancing priorities for prevention and care Bulletin of the World Health Organization, 89 (8), 547-547 DOI: 10.2471/BLT.11.091967
Danaei, G., Finucane, M., Lu, Y., Singh, G., Cowan, M., Paciorek, C., Lin, J., Farzadfar, F., Khang, Y., Stevens, G., Rao, M., Ali, M., Riley, L., Robinson, C., & Ezzati, M. (2011). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants The Lancet, 378 (9785), 31-40 DOI: 10.1016/S0140-6736(11)60679-X


Written by nascenthack

August 13, 2011 at 5:31 pm

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